Sir, we wish to thank Dr Short for her letter and would like to clarify a few points made about our Cochrane review.1

Firstly, the review does not suggest that extracting primary teeth is unhelpful, it does, however, point out to clinicians that the practice of extracting primary canines to aid the eruption of palatally displaced canines is not evidence-based. The study by Ericson and Kurol, from which the Royal College Guidelines are based, is a cohort study with no control.2,3

Dr Short commented that neither their study or the study by Ericson and Kurol were referenced; I suggest she reads the full review as both are quoted and referenced. With regard to the accompanying photograph of an infant shown in the news bulletin (BDJ 2009; 206: 454) we agree this was inappropriate; the authors of the review were not involved in this publication. The full review states '80% of participants should be aged between ten and 13 years' and intervention prior to age ten is contra-indicated.

The example provided by Dr Short of a patient with bilaterally impacted canines is of interest, however, it is a 'case report' and therefore does not add to our evidence base. We appreciate that clinical experience is of great value, expert opinion and case reports help us to make treatment decisions. Our feeling is that we still need to question our practice even when it is well-established.

In conclusion, the review neither discourages nor encourages the extraction of primary canines. It does clarify the need for well designed randomised clinical trials on this topic. I suggest that the review is read in its entirety. If anyone is interested in carrying out a randomised clinical trial on this subject, then I hope our systematic review is of help.